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Ren XL, Daa T, Yada N, Kashima K, Fujitomi Y, Yokoyama S. Expression and mutational status of RON in neoplastic lesions of the breast: analysis of MSP/RON signaling in ductal carcinoma in situ and invasive ductal carcinoma. APMIS 2012; 120: 358–67. Recepteur d’origine nantais (RON) is a receptor tyrosine kinase closely related to MET and involved in tumorigenesis. We investigated the roles of aberrations in RON and its ligand, macrophage-stimulating protein (MSP), in invasive ductal carcinoma (IDC, n = 81), ductal carcinoma in situ (DCIS, n = 26), and in benign lesions (n = 20) of mammary gland. Expression of RON and MSP was evaluated by immunohistochemistry and the mutational status of a region containing the proteolytic cleavage site in exon 1 and each exon of the kinase domain (exon 14–20) of RON was screened by polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) analysis. The proportion of cases positive for RON expression was significantly different between malignant [86% (92/107)] and benign [40% (8/20)] lesions. RON expression was positive in both IDC and DCIS [90% (73/81) and 73% (19/26), respectively], whereas MSP expression was present in 54% (44/81) of IDC and absent in DCIS. RON expression correlated significantly with the histological grade of DCIS. No mutations were detected in the examined regions of RON in breast cancer samples as confirmed by PCR-SSCP. The findings suggest the involvement of RON expression in the development of breast cancer, and that an autocrine/paracrine loop of RON seems to affect tumor invasiveness.

症例は67歳，女性．17年前に乳癌で左乳房切除術の既往あり．5年前の検診CTで右肺S8微小結節指摘され定期通院していた．同部は著変なかったが左舌区に淡い結節出現，TBLBにて肺腺癌の確診が得られ手術となった．術前CTでは一部胸膜肥厚あるも病的意義なしと判断していた．胸腔内観察したところ胸腔内全体に播種と思われる多発粟粒結節あり，舌区腫瘍表面にも播種を認め舌区の部分切除のみ施行した．肺癌の播種は考えにくく，術中病理診においても胸膜病変は乳癌胸膜転移とされた．最終病理においても肺内病変はER，PgR陰性，TTF-1陽性で肺腺癌，胸膜病変はER，PgR陽性でTTF-1陰性であり，類似した組織像であるが乳癌の転移播種と診断した．乳癌晩期再発報告は散見されるが，常にその可能性を念頭に置き精査加療を行わなければならない．

Objective: We conducted an empirical study to clarify how psychosocial factors (e.g. body image and sexuality) influence therapeutic decision-making and to identify the factors that affect post-operative mood states in Japanese women who underwent various types of surgery. Methods: One hundred and two patients who had undergone surgical treatment for breast cancer participated in this study. Twenty-five patients had undergone mastectomy, 67 breast conserving treatment and 11 skin-sparing mastectomy and immediate breast reconstruction. The participants were evaluated based on a battery of questionnaires including value estimates of decision-making factors, a shortened version of the Profile of Mood States and selfefficacy. Results: The patients regarded the possibility of cure and recurrence of cancer as well as the physician’s support as important, regardless of the treatments they had chosen. The patients that had immediate breast reconstruction placed significantly more importance on their body image and sexuality (i.e. physical appearance, attractiveness to partner and self-evaluation of femininity and sexuality) than the mastectomy patients. After surgery, the former group tended to have a more negative mood on the shortened version of the Profile of Mood States than the latter group. Degree of self-efficacy had a marked influence on the patients’ mood after surgery. Conclusions: This study suggests the importance of discussing body image and sexuality that has tended to be disregarded in therapeutic decision-making situations in breast cancer patients in Japan. Self-efficacy is a crucial variable for improving mood after treatment.

An 85-year-old woman was hospitalized with severe melena of unknown origin. Upper gastrointestinal (GI) endoscopy and lower GI endoscopy did not detect the origin and we could not establish any diagnosis. To explore the bleeding site, 99mTc-HSA blood loss scintigraphy was performed and a tumor of the small intestine was suspected. Fluoroscopic examination of the small intestine and abdominal CT scan confirmed an ileal tumor measuring 4×3 cm. The mass was a well-demarcated tumor about 80 cm proximal to Bauhin's valve. Partial resection of the ileum was carried out and the tumor was histologically diagnosed as schwannoma. Thereafter, there has been no recurrence of melena nor metastasis of the tumor. It is thought that blood loss scintigraphy is a useful method for unexplained exacerbation of melena.(Internal Medicine 42: 1178-1182, 2003)

十二指腸膜様狭窄は稀な先天性疾患であり,多くは幼児期に診断され,成人例は少ない.今回成人になって診断された十二指腸膜様狭窄の1例を経験したので報告する. 症例は52歳,女性.主訴は右季肋部痛,小児期より過食後に,しばしば腹痛を認めていた. 1年前腹痛を認めたため当院を受診した.上部消化管造影および上部消化管内視鏡検査にて十二指腸下行脚に膜様狭窄を認めた. Vater乳頭は膜様部近傍の口側に存在した.十二指腸膜様狭窄による逆行性胆管炎の診断で,絶食,経静脈栄養を施行した.膜様狭窄に対して手術を勧めたが,拒否したため経過観察とした.平成12年3月始め頃より腹痛を認めたため, 3月10日,加療目的で入院した.開腹下に十二指腸下行脚を縦切開し膜様物を切開し,一部切除した.術後,狭窄は消失し,経過は良好であった.手術に際しては乳頭の位置を確認し,胆管,膵管開口部を損傷しないように留意することが重要である.

症例は60歳女性。主訴は頸部, 項部, 腋窩部, 腹部, 陰部, 鼠径部の色素沈着および掻痒感で, 皮膚生検にて黒色表皮腫と診断された。上部消化管内視鏡検査にて胃体上部後壁にBorrmannIII型進行胃癌を認めた。胃全摘術を施行したが, 術後1年9か月後に癌性腹膜炎にて死亡した。黒色表皮腫は悪性腫瘍の合併率が高く, 特に胃癌との合併が多く報告されている。皮膚症状は胃癌の発見につながるもので, 黒色表皮腫に対しては, 特に胃癌の合併を念頭に置いた定期検診を行うべきであると考える。

A 26-year-old man came to our hospital with the chief complaint of abdominal pain. Based on the results of endoscopy and duodenography, the patient was diagnosed as having pancreatitis caused by a duodenal web. From childhood, the patient had frequently experienced postprandial abdominal distension and vomiting. After the age of 20 years, he had relapsing pancreatitis. When a part of the web was endoscopically excised, the symptoms disappeared. The preoperative relationship between the location of the duodenal papilla and the web is unclear in most cases of duodenal web. Therefore, in order to safely perform endoscopic treatment of duodenal webs, a small incision of the web should be initially made with duodenographic guidance. Subsequently, the relationship between the duodenal papilla and the web should be confirmed by endoscopic retrograde cholangiopancreatography and the remaining web should be excised.

BACKGROUND AND OBJECTIVE Possible mechanisms that promote or interfere with the effects of laser ablation of the liver have not been clarified. The aim of this study was to define the chronological alterations in the normal rabbit liver at early stages after laser ablation. STUDY DESIGN/MATERIALS AND METHODS Rabbit livers were ablated with a laser via an optical fiber and then analyzed histopathologically by immunostaining for heat shock protein 70 (HSP70) and by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) method. RESULTS The lesions increased in size progressively over the 24 h that followed ablation and the area of the lesion coincided with the area that had been heated above 43 degrees C. TUNEL-positive hepatocytes were surrounded, at some distance, by HSP70-positive hepatocytes were surrounded, at some distance, by HSP70-positive hepatocytes at 6 h, and such cells were in contact with each other at 24 h. CONCLUSIONS Injury to hepatocytes induced by laser ablation increases for 24 h and dying cells express nuclear HSP70, with subsequent fragmentation of DNA.

Recepteur d'origine nantais (RON) is a receptor tyrosine kinase closely related to MET and involved in tumorigenesis. We investigated the roles of aberrations in RON and its ligand, macrophage-stimulating protein (MSP), in invasive ductal carcinoma (IDC, n = 81), ductal carcinoma in situ (DCIS, n = 26), and in benign lesions (n = 20) of mammary gland. Expression of RON and MSP was evaluated by immunohistochemistry and the mutational status of a region containing the proteolytic cleavage site in exon 1 and each exon of the kinase domain (exon 14-20) of RON was screened by polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) analysis. The proportion of cases positive for RON expression was significantly different between malignant [86% (92/107)] and benign [40% (8/20)] lesions. RON expression was positive in both IDC and DCIS [90% (73/81) and 73% (19/26), respectively], whereas MSP expression was present in 54% (44/81) of IDC and absent in DCIS. RON expression correlated significantly with the histological grade of DCIS. No mutations were detected in the examined regions of RON in breast cancer samples as confirmed by PCR-SSCP. The findings suggest the involvement of RON expression in the development of breast cancer, and that an autocrine/paracrine loop of RON seems to affect tumor invasiveness.

In order to enhance postoperative recovery, preoperative consumption of carbohydrate (CHO) drinks has been used to suppress metabolic fluctuations. Trace elements such as zinc and copper are known to play an important role in postoperative recovery. Here, we examined the effects of preoperatively consuming a CHO drink containing zinc and copper.Subjects were 122 elective surgery patients divided into two groups (overnight fasting and CHO groups); each group was further divided into morning or afternoon surgery groups. Subjects in the CHO group consumed 300 mL of a CHO drink the night before surgery, followed by 200 ml before morning surgery or 700 ml before afternoon surgery (or =2 hours before anesthesia induction). Blood levels of glucose, nonesterified fatty acids (NEFA), retinol-binding protein, zinc, and copper were determined.One subject in the CHO group was excluded after refusing the drink. There were no adverse effects from the CHO drink. NEFA levels increased in the fasting groups. Although zinc levels increased in the CHO group immediately after anesthesia induction, no group differences were observed the day after surgery.Preoperative consumption of a CHO drink containing trace elements suppressed preoperative metabolic fluctuations without complications and prevented trace element deficiency. Further beneficial effects during the perioperative period can be expected by adding trace elements to CHO supplements.

42歳女性で超音波検査により発見された胃重複症の1例を経験したので報告する.超音波検査, computed tom Ography (以下CT) 検査で肝左葉下方, 胃小弯側に接して境界明瞭な球状の嚢胞を認めた.上部消化管造影, 胃内視鏡検査では噴門部小弯に3×3cmの表面平滑でなだらかな隆起があり, 胃壁外性腫瘤で胃内腔との交通はなかった.手術所見では腫瘤は胃壁小弯と連続しており, 胃壁を一部含めて摘出した.摘出標本では径4cmの嚢胞で膿汁様液が充満していた.病理組織学的には粘膜, 筋層, 衆膜の層構造を呈していた.粘膜上皮は多列円柱上皮で杯細胞もみられた.筋層の一部は胃壁の筋層と連続していた.胃内腔との交通はなかった.今後超音波検査, CT検査で発見される腹腔内襲胞では本疾患も念頭におくべきである.

若年者胃癌22例23病巣について胃癌取扱い規約に基づいて臨床病理学的検索を行った. 年齢は20歳から29歳, 平均26.3歳で, 男女比は1.4: 1であった. 頻度は切除胃癌の2.9%で, 初発症状では消化性潰瘍を示唆するものが多かった. 占居部位はMが78.3%を占めた. 肉眼型分類では0型が52.2%で, 3, 4型は合計30.4%と低率であった. 組織学的分類では低分化型が87%と多かった. 組織学的進行程度はstage Iが50%, IVは13.6%と低率であった. 手術成績は切除率100%, 治癒切除率86.4%であり, 遠隔成績は切除例の実測5生率は76.5%で, 治癒切除例のそれは92.9%であった. 若年者胃癌治癒切除例の予後は一般胃癌よりも優れた成績であった.

教室における原発性肝癌49例の臨床と外科的治療の概略をのべ,外科的切除した細小肝細胞癌の4例について臨床病態と病理組織学的検討を加えた.外科的治療49例中切除例は20例,41.7%,うち硬変合併肝は16例で,耐術例での予後では65%が硬変進行による肝不全死であった.細小肝細胞癌の臨床検査では血清AFP 3例中2例,HBs抗原4例中2例が陽性で,肝血管造影及び肝シンチでは各々3例に腫瘍が捕捉され有力な診断法であった.腫瘍の肉眼型は全て単結節型で腫瘍被膜を有し,肝被膜を破ったものが2例,腫瘍内壊死形成が3例にみられた.組織学的には全例に腫瘍被膜外への浸潤がみられ,細胞異型度はEdmondson II typeが主で,非癌部組織には肝硬変及び線維化がみられた.門脈内腫瘍血栓は2例に認め,1例が15ヵ月後に肺及び肝内転移で死亡した.腫瘍径が3cm以上になると組織学的に進行癌の様相を呈しているため充分なる肝葉切除あるいは区域切除の必要性を強調した.

Leiomyosarcoma of the residual stomach is extremely rare. Including the present case, there have been only six cases reported in Japan. A 71-year-old female who had undergone gastrectomy and gastroduodenostomy (Billroth I) because of gastric ulcer was admitted mainly with complaint of epigastralgia 11 years after the first surgery. By upper gastrointestinal series, gastrofiberscopic examination and CT-scan, she was diagnosed to have submucosal tumor of the residual stomach. Angiography of the celiac axis demonstrated a tumor stain with hypervascularity, which was supplied by the left gastric artery and the short gastric artery. Total resection of the residual stomach with dissection of the lymph nodes and reconstruction by Roux-Y method were performed. The resected tumor measuring 16×11×8cm in size showed exogastric growth, and no ulcer was observed on the mucasal surface of the tumor. Histology of the specimen revealed leiomyosarcoma. She showed metastasis in the liver 11 months after the second surgery. The clinical and pathological characteristics of leiomyosarcoma of the residual stomach are similar to that of leiomyosarcoma of the no-treated stomach.